Eddie Haywood
Since December of last year, 5,000 doctors employed in public hospitals across Kenya have been on strike, citing low pay and dreadful working conditions. The strike has highlighted the sharp crisis afflicting the health care system in the East African country.
The strike was called by the Kenya Medical Practitioners, Pharmacists and Dentists Union (KMPDU) to demand the implementation of an agreed-upon 2013 collective bargaining agreement with the Ministry of Health, which guarantees a 300 percent pay increase for doctors as well as funding for new medical equipment and new facilities. The Kenyan government claims there are no funds to implement the 2013 agreement.
Striking doctors have described via social media the horrid conditions afflicting public-run hospitals. These include power outages during surgeries with patients still on operating tables, not being able to run proper protocols in post-exposure prophylaxis, preventing the spread of HIV due to lack of equipment and being made to stand by helplessly while critically wounded patients die due to a lack of ambulances to take them to another hospital specializing in intensive care. Doctors also described being forced to work without drugs, gloves and other instruments critical in delivering care to patients.
For many years, Kenya’s public health care system has been starved of funding from the annual budget and beset by corruption in the Ministry of Health. The last several years have seen an exodus of medical personnel to the private sector due to the appallingly low pay in the public-run system. Many Kenyans must use the public-run medical system because they cannot afford the high cost of private care.
Also afflicting public hospitals is the lack of funding for new medical equipment essential for delivering adequate care. Shortages in funding for neglected facilities have left public hospitals in a dilapidated state, posing serious sanitation risks to patients and staff.
Dr. Judy Karagania, an ophthalmology resident at Kenyatta National hospital in Nairobi taking part in the strike, described the horrid conditions to the Guardian in an interview last month: “The machines break down frequently, the doctors are overwhelmed. The patients, they are so many that they are lying on the ground.”
Another participant in the strike, Dr. Cynthia Waliaula, told the Kenyan Daily Nation of the heart-wrenching experience of losing a newborn infant, due to the hospital at which she was employed in the town Isiolo having only two oxygen tanks. “I think every Kenyan doctor has had to decide who gets oxygen. You are forced to play god,” Waliaula lamented.
In February Dr. Davis Ombui, spokesperson for the KMPDU, expressed the health care catastrophe to Voice of America: “We know many Kenyans are losing their lives. Even us as doctors, we have relatives, we have friends, we have family and it has affected us all. But the narrative we are sticking to is that we cannot go back and supervise deaths as it were.”
In the more than three months since the strike began, public hospitals across the country have seen delivery of medical services come to a standstill, leaving millions without health care. The Kenyan media has resorted to a campaign of blackguarding the doctors, blaming them for the crisis sparked by criminal underfunding.
Despite the efforts of the media, there is broad favorable sentiment within the Kenyan masses for the doctors’ grievances. The government is widely perceived and despised by the masses as the guilty party for its refusal to adequately fund the health care system.
The government of President Uhuru Kenyatta is keen to put an end to the strike, fearing a wider explosion of social outrage by workers throughout the country. On February 13, the government jailed seven union officials for a month for refusing to end the strike. This provoked a 48-hour solidarity strike by medics in the private sector. A Kenyan appeals court ordered the release of the union officials to carry negotiations.
In a statement to the press in January, Kenyatta denounced the striking doctors: “I have noted, with deep concern, the suffering of Kenyans as a result of the ongoing strike by health workers in government facilities. This strike is totally unacceptable and goes against the Hippocratic Oath and basic principles of humane consideration for fellow Kenyans.”
This cynical appeal to principle is particularly offensive, given the record of the Kenyan government’s refusal to increase government spending for health care.
Overseen by the Ministry of Health, public hospitals accounted for around 4 percent of government spending. The Kenyan government budget for the 2016 fiscal year was nearly $20 billion, of this a mere $228 million was allocated to Kenya’s public health care system. This paltry amount allocated for the health care of a nation of 46 million underscores the depth of the current crisis.
In addition to the paltry amount of funding for the public health care system Kenya’s government is beset by nepotism and corruption. An internal audit of the Ministry of Health leaked last year revealed that nearly $50 million was looted by Ministry of Health officials, accounting for a whopping 21 percent of the entire funds earmarked for the 2016 fiscal year.
The auditors stressed that the amount may be just a fraction of the total stolen, as the audit had not yet been completed for the entire account of the Ministry’s transactions for 2016. According to Business Daily Africa, the audit report to Secretary of Health Cleopa Mailu explained, “The small sample covered is an indicator that there could be a wider scheme wherein the ministry incurred huge losses to the detriment of service delivery to the public.”
The current crisis underscores the fact that capitalism cannot provide decent and humane health care to the Kenyan masses.
Kenya is home to some of the wealthiest Africans, including current President Kenyatta, who is worth $500 million. While the total accumulation of wealth by the top 10 richest individuals in the country totals nearly $3 billion dollars, the majority of Kenyans survive on only $2 or less a day.
According to UNICEF, some 44 percent of the Kenyan population lives below the poverty line, and access to decent health care is a luxury that they cannot afford. Kenya has one of the African continent’s worst HIV rates at 7.8 percent. Infant mortality stands at an appalling 74 out of every 1,000 births.
The cutting of basic services for the Kenyan masses fits with the broader overall pattern of governments worldwide in the wake of the crisis of capitalism which manifested itself with the economic breakdown in 2008, which are busy rolling back hard-won social gains attained by the working class over decades of struggle. Their aim is to make the world’s working class pay for the crisis of the capitalist system.
By comparison with the budget for health care, Kenya gave far more of its annual budget to its military, some $2.6 billion; 12 times the annual budget amount allocated for the public health care system.
A strike by university lecturers has deepened the government’s political crisis ahead of parliamentary elections in August. While the KMPDU has limited its appeals to the government, the courts and oppositional parties, the strike, above all, poses the need for the political mobilization of the working class against the demands of the international banks and their domestic servants.
Kenya is carrying out a nearly five-year proxy war in Somalia on behalf of Washington, which has resulted in a catastrophic famine and refugee crisis. The aim of this brutal invasion is to subjugate Somalia under the control of US imperialism, as a significant portion of the world’s ship borne oil supply passes its eastern coast moving from the Middle East through the Red Sea and into the Gulf of Aden.
The Kenyan strike is part of the growing wave of class struggle in Africa. On February 20, at least five people were killed in Guinea’s capital of Conakry during protests sparked by a three-week teachers strike against the government’s decision to dismiss or cut the salaries of many junior teachers after the latest civil service exams. Many students in the West African country took to the streets to defend their teachers.
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